Interpretive Report in Automated Diagnostic Hearing Test

ABSTRACT

A multimedia user interface for an automated diagnostic hearing test allows a patient to interact with the automated hearing test in order to conduct various hearing related tests. The patient is given instructions and guidance for every test, and can call the operator at any time for help. Warning messages and progress indicators are provided to help the patient gauge his progress. This allows the patient to test his own hearing with minimal or no assistance from an audiologist or other hearing health professional. The user interface also allows the operator to configure and customize the automated hearing test as needed. The results of the hearing related tests are summarized in a single report that is concise, convenient, and thorough. The report may include interpretive comments that point out possible inconsistencies, asymmetries, or areas of concern in the test results and, where appropriate, also recommend certain types of medical treatment.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to, and hereby incorporates byreference, U.S. Provisional Patent Application No. 60/713,538, entitled“Interpretive Report in Automated Diagnostic Hearing Test,” filed Aug.31, 2005.

FIELD OF THE INVENTION

This invention is directed in general to the field of audiology and inparticular to a user interface for an automated method and system ofassessing and analyzing hearing loss.

Description of the Related Art

According to recent studies, over 20 million people in the United Statesalone have some degree of hearing loss. The number of people worldwidewho have some degree of hearing loss is estimated to be much greater.Not surprisingly, many of these people are unaware that they havesuffered a decrease in hearing capacity. The decreased hearing capacitymay be due to several factors, including age, health, occupation,injury, and disease. This loss of hearing can lead to significantreductions in quality of life, impaired relationships, reduced access toemployment and diminished productivity. Failure to treat the hearingloss may worsen the impact. According to the Better Hearing Institute,the annual cost in the United States in terms of lost productivity,special education, and medical care because of untreated hearing loss isapproximately $56 billion. Much of this staggering cost can be reducedor prevented by early detection and treatment. Unfortunately, few peopleobtain regular and frequent hearing tests as a part of their routinehealthcare due, in part, to the lack of a simple, convenient, andrelatively inexpensive hearing test.

Traditionally, a hearing test is conducted in a clinical setting by ahearing health professional, such as an audiologist, who administers thehearing test manually. The hearing health professional controls anaudiometer to produce a series of tones that each have a very specificfrequency and intensity. The term “intensity” as used herein refers tothe amplitude of the tone and is usually stated in decibels (dB). Thetones are then conducted through a transducer, such as earphones or earinserts, to the patient in a quiet room or sound isolation booth. Foreach audible tone, the patient gestures or otherwise indicates that hehas heard the tone. If the tone is not audible, the patient does notrespond. The hearing health professional thereafter adjusts theintensity level of the tone in preset increments until it becomesaudible to the patient. By repeating this process for several differenttones and compiling the results, the hearing health professional is ableto determine the extent of the hearing loss, if any.

An advantage of having a hearing health professional manually administerthe hearing test is the hearing health professional can apply hisconsiderable training and experience during the test. For example, bysimply talking to the patient and varying the loudness of his voice, thehearing health professional can determine an initial intensity level atwhich to start the tones. Furthermore, the hearing health professionalcan adapt the pace of the test as needed to accommodate a tired oruncooperative patient. More importantly, the hearing health professionalcan discern between false responses or guesses and responses that arelegitimate. Finally, the hearing health professional can adjust theresults of the hearing test as needed to reflect extenuatingcircumstances or problems, such as excessive ambient noise, equipmentlimitations, and other similar factors.

Like most highly trained and specialized medical professionals, however,a hearing health professional's time and services are usually expensive.Accessibility and convenience may also be issues, as there are fewerhearing health professionals relative to other types of medicalprofessionals. And while hearing health professionals are highlytrained, they are limited in their ability to make rapid and accuratecalculations of the test data and must rely on approximations and rulesof thumb for guidance in many instances. In addition, few hearing healthprofessionals in the United States can speak a foreign language. As aresult, traditional hearing tests are almost always administered inEnglish, which can present a problem for non-English speaking patients.

Other drawbacks of the traditional, manually administered hearing testsinclude the need for a quiet room or sound isolation booth in order toproperly conduct the tests. The quiet room or sound isolation booth hasto comply with ANSI (American National Standards Institute) requirementsin terms of how much noise may penetrate the room or booth during atest. Typically, a specially trained technician must evaluate andcertify the quiet room or sound isolation booth as meeting ANSIstandards before the room or booth can be used. At present, there arerelatively few technicians who are trained to perform such evaluationsand certifications. All the above factors combine to increase thecomplexity of the traditional hearing tests and thereby discourage or atleast contribute to a general lack of interest by most people inobtaining regular and frequent hearing tests.

One attempt to simplify the traditional hearing test involves the use ofa computer network, such as the Internet, to administer the test. Thecomputer network facilitates interaction between a centralized testadministration site and remotely located patient sites. Such anarrangement makes it possible (or at least more convenient) for peoplein remote or rural areas to obtain a hearing test. And the hearing testcan be performed so that it meets standardized guidelines such as ANSIrequirements or certification standards. Despite the increasedconvenience, a hearing health professional must still manuallyadminister the test, albeit remotely. In this regard, the test is verysimilar to the traditional hearing test and has many of the sameshortcomings.

Accordingly, what is needed is a hearing test that overcomes theshortcomings of the traditional hearing test. Specifically, what isneeded is a hearing test, and a user interface therefor, that issimpler, more convenient, less expensive, can be administered by thepatient instead of the hearing health professional, yet does notcompromise the accuracy or thoroughness of the traditional, manuallyadministered hearing test.

SUMMARY OF THE INVENTION

The present invention is directed to a multimedia user interface for anautomated diagnostic hearing test. The user interface allows a patientto interact with the automated hearing test in order to conduct varioushearing related tests. The patient is given instructions and guidancefor every test, and can call the operator at any time for help. Warningmessages and progress indicators are provided to help the patient gaugehis progress. This allows the patient to test his own hearing withminimal or no assistance from an audiologist or other hearing healthprofessional. The user interface also allows the operator to configureand customize the automated hearing test as needed. The results of thehearing related tests are summarized in a single report that is concise,convenient, and thorough. The report may include interpretive commentsthat point out possible inconsistencies, asymmetries, or areas ofconcern in the test results and, where appropriate, also recommendcertain types of medical treatment.

BRIEF DESCRIPTION OF THE DRAWINGS

A better understanding of the invention may be had by reference to thefollowing detailed description when taken in conjunction with theaccompanying drawings, wherein:

FIG. 1 illustrates an exemplary system for providing an automatedhearing test according to embodiments of the invention;

FIG. 2 illustrates a block diagram of a system having a user interfacefor an automated hearing test according to embodiments of the invention;

FIG. 3 illustrates an exemplary user interface for an automated hearingtest according to embodiments of the invention;

FIG. 4 illustrates an exemplary implementation of a patient inputcomponent of the user interface according to embodiments of theinvention;

FIGS. 5A-5M illustrate an exemplary implementation of a systemconfiguration component of the user interface according to embodimentsof the invention;

FIGS. 6A-6B illustrate an exemplary implementation of a tympanometry,acoustic reflex, and otoacoustic emission component of the userinterface according to embodiments of the invention;

FIGS. 7A-7B illustrate an exemplary implementation of a portion of apatient training component of the user interface according toembodiments of the invention;

FIGS. 8A-8I illustrate an exemplary implementation of a patient testingcomponent of the user interface according to embodiments of theinvention;

FIG. 9 illustrates an exemplary implementation of a patient managementcomponent of the user interface according to embodiments of theinvention;

FIGS. 10A-10F illustrate an exemplary implementation of a reportingcomponent of the user interface according to embodiments of theinvention; and

FIGS. 11A-11C illustrate an exemplary hearing test report according toembodiments of the invention.

DETAILED DESCRIPTION OF THE INVENTION

Following is a detailed description of the invention with reference tothe drawings wherein reference numerals for the same or similar elementsare carried forward. It should be noted that unless otherwise indicated,the design and layout of the various features shown in the drawings,including the size, shape, color (or lack thereof), location, andarrangement of the various fields, checkboxes, text boxes, graphics, andother information, are provided for illustrative purposes only, and theinvention is not to be limited to any particular design or layout.

As mentioned above, the present invention is directed to automatedtesting of a patient's hearing and, more specifically, to a userinterface for such an automated hearing test. The term “automatedtesting” as used herein refers to testing that is performed primarily bya computer, as opposed to testing that is performed primarily by ahearing health professional. The user interface allows the patient totest his own hearing with minimal or no assistance from a hearing healthprofessional. Typically, an operator, such as the hearing healthprofessional or a trained administrator, helps the patient with theinitial set up (e.g., seating, putting on the transducers, demonstratingbutton usage, etc.) and explains in general how the test works.Thereafter, the user interface instructs and prompts the patient throughthe remainder of the test.

Patients will realize a number of benefits from the user interface ofthe present invention. In general, the user interface is an intuitive,user-friendly interface that makes the automated hearing test simple touse and provides for a more pleasant and enjoyable patient experience.In addition, the user interface has a “high-tech” look and feel thatinspires confidence in the patient that he is using state-of-the-arttechnology that will produce more accurate results. Moreover, the userinterface provides a clear and consistent voice that may be easier tounderstand than some hearing health professionals who may speak with anaccent or whose speech may otherwise be difficult to understand.Finally, the user interface allows the patient to proceed with thehearing test at his own pace, since little or no assistance is neededfrom the hearing health professional.

Referring now to FIG. 1, a system 100 is shown for providing automatedhearing tests in which the user interface according to embodiments ofthe invention is used. The system 100 has three main components, namely,a computer 102, a display screen 104, and at least one transducer 106.Other components of the system 100 that may be present include atympanometer, keyboard, mouse, printer, paging system, and the like(indicated generally at 108). The paging system may be any suitablepaging technology that uses one or more pagers 108 for alerting theoperator. The one or more pagers 108 preferably can display textmessages for informing the operator of the nature of the alert. Othertypes of paging system may also be used without departing from the scopeof the invention (e.g., Internet based paging systems).

The computer 102 may be any suitable computer, from a desktop PC to ahigh-end workstation, as the particular type/model/brand of computer isnot overly important to the practice of the invention. The displayscreen 104 may likewise be any suitable display screen, from a CRT to anLCD, as the particular type/model/brand of display screen is not overlysignificant for purposes of the present invention. In some embodiments,however, a touchscreen monitor may be easier to use than conventionalCRT or LCD display screens in terms of the physical interaction betweenthe patient and the automated hearing test.

As for the transducer 106, this component may be an ear insert,earphones, and the like for air conduction testing. For bone conduction,the transducer 106 may be a vibrator or other similar devices. In somecases, the transducer 106 may be mounted on a headset worn by thepatient. Usually, a separate transducer is used for air conductionversus bone conduction and the transducers are swapped as need duringthe hearing test. Preferably, the bone conduction transducer is arrangedin such a way as to allow testing of either ear without moving thetransducer and without interfering with the air conduction transducer.An example of a transducer that may be used with the present inventionis described in U.S. patent application Ser. No. 10/438,751, entitled“Apparatus for Bone Conduction Threshold Hearing Test,” which is herebyincorporated by reference.

FIG. 2 illustrates the system 100 in block diagram form. As can be seen,the computer 102 has a number of functional components, including avideo unit 200, a central processing unit 202, a hearing test device204, and a storage unit 206. These components are well known in thecomputer art and will therefore be described only briefly here. Ingeneral, the video unit 200 provides the video signals that aredisplayed as images on the display screen 104. In some embodiments, thevideo unit 200 may be any one of several commercially available videocards. The central processing unit 202 is responsible for the overalloperation of the computer 102, including execution of the operatingsystem and any software applications residing on the computer 102. Insome embodiments, the central processing unit 202 may be any one ofseveral commercially available microprocessors. The hearing test device204 may comprise any or all of an audiometer, an otoacoustic emissiontest device, a tympanometer, a masking noise generator, or other hearingtest devices. In some embodiments, the hearing test device 204 may beone or more electronic circuit boards within the computer 102 forperforming the functionality of such test devices. Alternatively, thehearing test device 204 may be a separate unit that is external to thecomputer 102. The storage unit 206 stores the automated hearing test andprovides long-term and temporary (i.e., caching) storage for thesoftware and data that are used by the computer 102 and may include oneor more of, for example, a hard drive, main memory, removable storage(e.g., CD-ROM, floppy disk), and the like.

In some embodiments, the storage unit 206 also stores a multimedia userinterface 208 for the automated hearing test. More specifically, thestorage unit 206 stores a computer-readable version of the userinterface 208 that can be executed by the computer 102. Duringexecution, a portion of the user interface 208 may be temporarily loadedfrom, for example, the hard disk and into the main memory components ofthe storage unit 206. In addition to the stand-alone arrangement, it isalso possible to execute the user interface 208 from a network. Forexample, the user interface 208 may be stored on a server computer (notexpressly shown) that is accessible to several client computers. Thisarrangement has an advantage in that updates to the user interface 208may be quickly and easily implemented for all client computers via theserver computer. Other environments for executing the user interface 208may also be used without departing from the scope of the invention.

FIG. 3 shows an exemplary implementation of the user interface 208. Ascan be seen, the user interface 208 has a number of functionalcomponents, including a patient input component 300, a systemconfiguration component 302, a tympanogram, acoustic reflex (AR), andotoacoustic emission testing component 304, a patient training component306, a patient testing component 308, a patient management component310, a reporting component 312, and an interpretive comments component314. The various functional components are typically executed insequence as the automated hearing test progresses, but any functionalcomponent can be executed before, during, or after execution of anyother functional component as needed. In addition, each functionalcomponent 300-314 may be a modular, stand-alone component that iscapable of accepting data from and/or passing data to other functionalcomponents. This modularized approach allows individual functionalcomponents 300-314 to function independently of other functionalcomponents such that one or more functional components may be removedfrom the user interface 208 and/or inserted into another user interface(not expressly shown) with little or no modification. Operator and/orpatient interaction with the user interface 208 may be accomplishedusing any suitable input device, for example, a mouse, keyboard,separate dedicated response button, or using a touchscreen display unit.Where a touchscreen display unit is used, the user interface 208 maydisplay a graphical keyboard (in addition to or instead of aconventional keyboard) from which the operator and/or patient may selectalphanumeric characters as needed.

Briefly, the patient information component 300 allows the operatorand/or the patient to enter basic information about the patient and toselect which hearing related tests to perform for the patient. Thesystem configuration component 302 allows the operator to customconfigure various aspects of the automated hearing test according to hispreferences. The tympanogram, acoustic reflex, and otoacoustic emissiontesting component 304 facilitates obtaining a tympanogram and/or AR testfor the patient. The patient training component 306 providesinstructions for and guides the patient in the use of the automatedhearing test prior to as well as during the actual testing. The patienttesting component 308 allows the patient to interact with the automatedhearing test based on the particular hearing related tests beingperformed (e.g., pure tone threshold, speech reception threshold, andspeech discrimination). The patient management component 310 notifiesthe operator and/or the patient of any problems or contingencies thatmay arise during testing and generally helps the patient stay on course.The reporting component 312 allows the operator to view and print theresults of the testing, as well as to store the results of the testingin various formats. Finally, the interpretive comments component 314point out possible inconsistencies, asymmetries, or areas of concern inthe test results and, where appropriate, recommends certain types ofmedical treatment. Each of the above functional components will now bedescribed in more detail.

Referring now to FIG. 4, an exemplary implementation of the patientinformation component 300 is shown. In some embodiments, the patientinformation component 300 may include a new session screen 400. This isthe first screen to be displayed after powering on the system 100 andfunctions to allow the operator and/or the patient to enter certainitems of basic information for the patient. For example, the new sessionscreen 400 may include a chart number field 402 for entering thepatient's chart number and a patient name field 404 for entering thepatient's name. This information, along with the date and possibly otherinformation, may be used to store and subsequently retrieve the resultsof any test session. In addition, because the automated hearing test iscapable of testing in multiple languages (e.g., English, Spanish,French, etc.), in some embodiments, the new session screen 400 may alsoinclude a field 406 for selecting which language to be used to test thepatient. The new session screen 400 may also include a plurality ofcheckboxes 408 for selecting which hearing related tests will beperformed for the patient. For example, the new session screen 400 mayinclude a checkbox for selecting a tympanogram test, an acoustic reflextest, and a distortion product (DP) otoacoustic emission test. Alsoavailable for selection are an air and bone conduction test, a speechreception test, and a speech discrimination test. Selecting a patientsurvey allows the automatic hearing test to gather certain hearingrelated information about the patient that can be used by the hearinghealth professional to diagnose and recommend treatment.

From the new session screen 400, the operator may access variousfunctions related to the automatic hearing test by pressing theappropriate buttons. For example, pressing a view reports button 410allows the operator to view patient reports previously stored on thesystem 100. This aspect of the invention will be described later hereinwith respect to the reporting component 312. The operator may also pressan advanced options button 412 to view and select various advancedoptions related to a manual testing feature of the automated hearingtest. Such annual testing allows the hearing health professional tomanually administer the hearing test using various functions of theautomated hearing test (i.e., computer-assisted audiometry). An Offbutton 414 allows the operator to turn the automated hearing test off.Finally, a reconfiguration button 416 allows the operator to initiatethe system configuration component 302 of the user interface 208,described below.

FIGS. 5A-5M illustrate an exemplary implementation of the systemconfiguration component 302 of the user interface 208. In someembodiments, the system configuration component 302 includes a pluralityof screens, each screen presenting a different set of systemconfiguration options from which the operator may select. It should benoted that not all screens need to be present in every embodiment, andthat additional screens not expressly shown may be present in someembodiments.

In one embodiment, the system configuration component 302 may include aninput screen 500. The input screen 500 may have an information selectionarea 502 that allows the operator to select various items of informationto be entered for the patient. The information selection area 502 mayinclude fields for the doctor's name, the clinic's name, the patient'sdate of birth, the patient's gender, and the name of the operator. Theinformation selection area 502 also allows the operator to choosewhether to make certain information items optional only, or requiredinformation. Thereafter, at the start of each new test session, the newsession screen 400 displays all the fields in the information selectionarea 502 selected by the operator and then waits for the patient and/orthe operator to fill in the fields, either on an optional or a requiredbasis.

In some embodiments, the input screen 500 may also include fields forentering default settings for some of the information items. Forexample, the input screen 500 may include a default doctor's name field504, a default administrator's name field 506, a default clinic's namefield 508, and a default chart number field 510. In some embodiments,the input screen 500 may further include an area for entering severaldefault doctor names into a list 512 and several default administratornames into a list 514. The names that are entered into the lists maythen be used as default options in a drop-down list from which theoperator and/or the patient may select to fill out the informationfields. To add or remove a name from the list, one simply clicks on theappropriate “Add” or “Remove” buttons as needed. To scroll through thelist, one simply clicks the “Up” or “Down” navigation buttons as needed.

In some embodiments, the system configuration component 302 furtherincludes a paging encoder interface screen 520. By way of background,the automated hearing test typically includes a patient response systemthat allows the operator to monitor the patient's progress during thehearing test and also allows patient to contact the operator, usuallyvia a pager, at any time during the test. The function of the pagingencoder interface screen 520 is to let the operator customize the pagingprotocol used by the automated hearing test. To enable paging, forexample, a check box 522 may be selected to indicate that a pagingdevice is attached to the automated hearing test. The paging encoderinterface screen 520 also makes available a plurality of options 524 forspecifying various parameters of the paging encoder interface, such asthe communications port, an encoder ID, an encoder timeout period, apager CapCode, and a pager data rate.

In some embodiments, the system configuration component 302 furtherincludes a paging options screen 530. The paging options screen 530allows the operator to select when a page will be issued. For example,the paging options screen 530 may include a check box 532 for paging theoperator at the end of the test session, a check box 534 for paging theoperator at the end of each test in the test session, a check box 536for paging the operator after a certain amount of inactivity by thepatient, and a check box 538 for paging the operator if the automatedhearing test cannot determine a pure tone threshold for the patientwithin a predetermined amount of time.

The paging options screen 530 also includes a plurality of pagingoptions 539 that allows the operator to customize certain aspects of thepage. For example, the operator may specify a short text message to besent with pages that occur at the end of a testing session, and a brieftext message to be sent with pages that occur at the end of each test.The operator may also specify a short text message to be sent with pagesthat occur due to inactivity, and to specify the inactivity threshold.Furthermore, the operator may specify a brief text message to be sentwith pages that occur due to the inability to reach a pure tonethreshold, and to specify the amount of time to wait for a threshold.

The paging device option 540 allows the operator to specify the type ofpaging mechanism. For example, the operator may specify a wireless orradio based paging mechanism, a web based paging mechanism wherein analarm (visual and/or audio) is issued on a web page monitored by theoperator, or an FTP based paging mechanism where a file is sent to theoperator to notify him of a paging event.

In some embodiments, the system configuration component 302 furtherincludes a machine options screen 544. The function of this screen is toallow the operator to assign a specific identifier to the automatedhearing test. This function is especially useful in clinics wheremultiple systems are used. For example, the machine options screen 544may include a machine identifier field 546 into which the operator mayenter an alphanumeric identifier for the particular automated hearingtest.

In some embodiments, the system configuration component 302 furtherincludes a reporting options screen 548. The function of this screen isto allow the operator to pre-configure the number of test reports to beprinted automatically after each testing session. For example, thereporting options screen 548 may include a field 550 for entering thenumber of reports to be printed automatically at the end of a testingsession (e.g., 2). In some cases, the reporting options screen 548 alsoincludes a field 552 for entering the minimum testing intensity levelthat the operator wishes to be reported (e.g., 0 dB).

In some embodiments, the system configuration component 302 furtherincludes a network options screen 554. The function of this screen is toallow the operator to specify where patient reports are stored on aparticular computer 102 of the automated hearing test. In the exampleshown, a field 556 indicates that the patient reports are stored in adirectory called “c:\inetpub\wwwroot\” of computer 102. When thecomputer 102 is accessed from a network, the information that will beavailable to the network is the patient reports that are stored in thespecified directory. Thus, any personnel with authorized access to thenetwork to which the computer 102 is connected may view the patientreports that are stored on the computer 102. In some embodiments, thecomputer 102 of each automated hearing test functions as a web server,and the field 556 indicates the web server root directory. In that case,the patient reports stored on the computer 102 may be viewed from thenetwork as a web page using any suitable web browser.

In some embodiments, the system configuration component 302 includes atest options screen 560. The function of this screen is to allow theoperator to configure various aspects of the hearing related tests thatwill be performed. For example, the test options screen 560 includes aplurality of checkboxes 562 that allow the operator to specify whichhearing related tests will be selected by default from the new sessionsscreen 400.

The test options screen 560 also includes a plurality of hearing relatedtest option screens, for example, a pure tone options screen 566.Because naming conventions for the various hearing related tests differfrom country to country, the pure tone test options screen 566 includesa naming field 568 to allow the operator to customize the test name usedfor this test in his clinic. The pure tone test options screen 566further includes frequency options 570 that allow an operator to specifywhen the various pure tone frequencies are tested. For example, theoperator may specify that a certain frequency is always tested, nevertested, or tested as needed. The operator may define the pure toneaverage (PTA) for the pure tone test by selecting one of severalpredetermined definitions at 572. A check box 574 allows the operator toalways use bone masking if he so desires.

In some embodiments, another hearing related test options screen that isincluded is the tympanometry options screen 576. This tympanometryoptions screen 576 allows the operator to specify various parameters forthe tympanometry test. For example, the tympanometry options screen 576includes field 578 where the operator may specify a name for the test,the communications port, and may select one of several available tomanometer. The tympanometry options screen 576 also includes field 580for allowing the operator to specify the starting pressure and theending pressure for the test. A plurality of calibration parameters 582allows the operator to enter calibration values for the left and rightears and to calibrate the tympanometer for those ears accordingly.

In some embodiments, the test options screen 560 further includes anacoustic reflex options screen 583 that can be used to specify variousparameters for the acoustic reflex test. For example, the acousticreflex options screen 583 may include a field 584 that allows theoperator to specify the name to be used with the test. Checkboxes 585allow the operator to specify which one of several available frequenciesto be used with the ipsilateral and contralateral ear. The initialintensity level, incremental intensity, and the reflex threshold levelmay also be specified in the fields shown at 586.

In some embodiments, yet another hearing related test options screenthat is included is the speech discrimination options screen 587. Thisscreen allows the operator to specify various parameters for the speechdiscrimination test, including the name of the test at 588. A pluralityof fields 589 allow the operator to specify, for example, the basepresentation level, the presentation type (e.g. closed, open), thenumber of presentations, the minimum presentation level, the maximumpresentation level, and the particular word list to be used.

In some environments, the test options screen 560 additionally includesa speech reception threshold options screen 590 that can be used tospecify various parameters for the speech reception threshold test. Forexample, the speech reception threshold options screen 590 may include afield 591 for specifying the name to be used for the test.

In embodiments where a patient survey is taken, the test options screen560 may include a survey options screen 592. This screen can be used tospecify various aspects of the survey at 593, including the name to beused for the survey, and the particular survey of several availablesurveys to be used. In some embodiments, the questions that are asked inthe survey may comply with the Hearing and Hearing Handicap Inventoryfor the Elderly (HHIE).

Finally, in some embodiments, the test options screen may include anotoacoustic emission options screen 594. The otoacoustic options screen594 may include a naming field 595 for specifying the name to be usedwith this test. A set of options 596 allows the operator to select whichone of several frequencies to test, set the response floor and noiseceiling, and specify the intensity levels L1 and L2.

FIGS. 6A-6B illustrate an exemplary implementation of the tympanometry,acoustic reflex, and otoacoustic emission component 304 of the userinterface 208. In some embodiments, the tympanogram, acoustic reflex,and otoacoustic emission component 304 includes a combination testscreen 600. The function of this screen is to allow the operator and/orthe patient to obtain a tympanogram, acoustic reflex, and otoacousticemission measurement for the patient. Note that although all three testsmay be performed from the same screen, only the tests that have beenselected will be performed. The tympanogram, acoustic reflex, andotoacoustic emission screen 600 may include a series of instructions forthe operator and/or patient that walks him step-by-step through theprocedure. The instructions may be presented in text, or they may bepresented verbally, or both. Where verbal instructions are presented, aconfirmation button (not expressly shown) may be pressed to confirmcompletion of each instruction and move on to the next instruction.While the test is being performed, the screen 600 may include a chart602 that captures the data being obtained for the tympanogram. The rawdata is shown generally at 604. The amount of pressure that is beingused is shown at 606. Pressing a command button 608 brings up a list ofcommands that may be selected (e.g., exit, pause, microphone on, etc.).Pressing a skip button 610 allows the operator and/or the patient toskip the current ear and move to the next ear.

When the tympanogram, acoustic reflex, and otoacoustic emission portionis completed, a screen 612 presents the final results. From this screen,the operator and/or patient may press an accept results button 614 toaccept the results, a redo right ear button 616 to redo the right ear,and a redo left ear button 618 to redo the left ear.

Once the tympanogram, acoustic reflex, and otoacoustic emission portionis completed and the results therefor accepted, the patient may proceedwith the remaining hearing related tests. First, however, the patientshould be given some instructions and guidance on how to proceed andwhat to expect. The patient training component 306 performs thistraining task. Patient training is given in two phases, a generaltraining phase where general instructions are given, and a test specificphase where instructions that are specific to a particular test aregiven before the test begins.

FIGS. 7A-7B illustrate an exemplary implementation of the general phaseof the patient training component 306. In some embodiments, the generaltraining phase includes a welcome screen 700. The function of thisscreen is to give the patient a general idea of how the automatedhearing test works in general. For example, the welcome screen 700 maydisplay some of the basic instructions (shown generally at 702) for theautomated hearing test. At the same time, the patient training component306 may cause a verbal welcome message to be played in the transducersworn by the patient. The welcome message may provide the patient withdetailed information about the upcoming tests. For example, the welcomemessage may explain that the tests are automated and therefore theoperator may not be in the room during the test, but that the patientmay press the help button at any time to call the operator. Volumecontrol buttons 704 allow the patient to increase or decrease the volumeof the welcome message as needed. If the patient wishes to skip themessage altogether, he may press the skip button 706.

Before discussing the patient training component 306 further, it may beuseful to discuss one aspect of the patient management component 310 ofthe user interface 208. In some embodiments, the patient managementcomponent 310 may include a progress indicator 708 that allows thepatient and/or operator to track the patient's progress for a given testsession. The progress indicator 708 may include a plurality of bubbles,one of which is shown at 710, to indicate the patient's current hearingrelated test. For example, there may be a bubble for the tympanometrytest, the acoustic reflex test, the otoacoustic emission test, the puretone threshold test, the speech reception test, and the speechdiscrimination test. The bubbles are empty at first, but as the patientbegins a particular hearing related test, the bubble for that test isfilled in. The color used to fill in the bubbles may be the same forevery bubble, or some type of progressive color scheme may be used(e.g., darker colors at the beginning stages and lighter colors at theend).

In some embodiments, the progress indicator 708 of the patientmanagement component 310 may also include progress bars 712 and 714. Theprogress bars 712 and 714 provide an indication of the completionpercentage of the total test session and of each individual hearingrelated test, respectively.

Continuing now with the general training phase of the patient trainingcomponent 306, if a progress indicator 708 is present, the patienttraining component 306 also provides training on how the patient cantrack the progress of his testing using the progress indicator 708. Forexample, after the welcome message is completed (or skipped), thepatient training component 306 may present a progress training screen720. The progress training screen 720 may display a text explanation 722of the basic feature of the progress indicator 708. In addition, oralternatively, a detailed verbal explanation of the progress indicator708 may also be presented. Both the text and verbal based trainingexplain to the patient how to interpret the plurality of bubbles 710 andthe progress bars 712 and 714.

After the general training stage is completed, the patient trainingcomponent 306 then provides the test-specific training. Thetest-specific training may be provided for the specific tests that areabout to be performed only, or it may be provided for all the availablehearing related tests. In addition, the test specific training may beprovided all at once and upfront before beginning any specific test, orthe training for a specific test may be provided one test at a timebefore beginning that hearing related test. This latter embodiment willnow be explained in conjunction with an explanation of the patienttesting component 308.

In general, at the beginning of each test, the patient trainingcomponent 306 presents the patient with an instruction screen and/or averbal explanation of the test. The instruction screen may show some ofthe basic instructions for the test and how to proceed, and the verbalexplanation may provide a more detailed explanation. The patient testingcomponent 308 then allows the patient to proceed with the actualtesting. FIGS. 8A-8I illustrate an exemplary implementation of thepatient testing component 308 and the test specific training portion ofthe patient training component 306.

For example, where the patient is getting ready to take the pure tonethreshold portion of the automated hearing test, the patient trainingcomponent 306 presents the patient with a pure tone threshold trainingscreen 800 and, in some cases, a verbal explanation thereof. The puretone threshold training screen 800 includes text 802 that lists some ofthe basic instructions for the pure tone threshold test. For example,the text may explain that the tones start loud, then get soft, thenpulse on and off. The training screen 800 may also present an example804 of the response button with an explanation that the patient is topush the button only when he hears a tone. The verbal explanation, whenused, may provide essentially the same information plus a few moredetails, such as the fact that one ear will be tested at a time, and mayalso provide a sample tone. Volume control buttons 806 allow the patientto control the volume of the verbal message, and a skip button 807allows the patient to skip the verbal message. A command button 808brings up a list of commands that may be used at this point.

After the pure tone threshold training is completed, the patient testingcomponent 308 presents the patient with a response screen 810 forresponding to the pure tone threshold test. The purpose of the pure tonethreshold test is to determine the patient's hearing threshold (i.e.,the softest level he can hear) at various frequencies or tones. To thisend, the response screen 810 may include a button 812 that the patientcan press each time he hears a tone. Where color is used, the button 812and the screen 810 may have a comfortable yet distinctive color schemethat helps the patient to concentrate on the test. For example, thebutton may be vivid color such as red, while the surrounding area mayhave a lighter, softer color. Other suitable color schemes may also beused here as well as throughout the various drawings. In addition, oralternatively, the patient testing component 308 may activate or engagea separate response button (not expressly shown) that the patient maypress each time he hears a tone. The automated hearing test thenpresents a series of tones to the patient, and the patient testingcomponent 308 waits for the patient to respond by pressing the button812. A help button 814 allows the patient to call the operator at anytime.

Where the patient is to undergo a speech reception threshold portion ofthe automated hearing test, the patient training component 306 presentsthe patient with a speech reception training screen 820 and, in somecases, a verbal explanation thereof. The speech reception trainingscreen 820 includes some of the basic instructions 822 for the test, forexample, that there will be X pictures, and that the patient shouldalways make a guess at the correct answer, even if he is not sure. Inaddition, the speech reception training screen 820 may also include anexample 824 of the test screen displayed during the test. The verbalexplanation, when used, may provide essentially the same informationplus a few more details, such as how many pictures will be shown to thepatient.

After the speech reception training is completed, the patient testingcomponent 308 presents the patient with a response screen 830 forresponding to the speech reception threshold portion of the automatedhearing test. The speech reception threshold test is used to determinethe softest level at which the patient can hear and recognize a word. Tothis end, the response screen 830 presents a set 832 of randomly chosenpictures (one shown at 834) to the patient along with the correspondingwords (one shown at 836) for the pictures. In some embodiments, thereare nine randomly chosen pictures and words in a set 832, and the sameset 832 is used for the entire speech reception threshold portion(although it is possible to use more than one set). Preferably, thewords that are used are compound words with two distinct syllables. Forlanguages where no such words are available, appropriate substitutionsmay be made. The automated hearing test then verbally presents the wordsto the patient one at a time, randomly, and at a decreasing intensitylevel, with no emphasis on any syllable. The patient testing component308 then waits for the patient to select the picture or word from theresponse screen 830 that matches the verbally presented word. Thisprocedure is performed for each ear until the lowest or softest verbalpresentation level at which the patient can correctly identify 50% ofwords is determined.

Where the patient is to undergo the speech discrimination portion of theautomated hearing test, the patient training component 306 presents thepatient with a speech discrimination training screen 840 and, in somecases, a verbal explanation thereof. The speech discrimination trainingscreen 840 includes some of the basic instructions 842 for the test, forexample, that there will be X pictures, and that the patient shouldalways make a guess at the correct answer, even if he is not sure. Inaddition, the speech discrimination training screen 840 may also includean example 844 of the test screen displayed during the test. The verbalexplanation, when used, may provide essentially the same informationplus a few more details, such as how many pictures will be shown to thepatient.

After the speech discrimination training is completed, the patienttesting component 308 presents the patient with a response screen 850for responding to the speech discrimination portion of the automatedtest. The speech discrimination test, unlike the pure tone threshold andspeech reception threshold tests, does not test for the softest levelthe patient can hear. Rather, the speech discrimination test checks tosee how well the patient is able to discern between similar soundingwords. To this end, the response screen 850 presents randomly chosensets 852 of pictures (one shown at 854) along with their correspondingwords (one shown at 856). The words 856 are preferably single syllablewords that sound alike. In some embodiments, there are four such words856 along with their corresponding pictures 854 in each set 852. Forlanguages where such words are not available, appropriate adjustmentsmay be made.

As each set 852 of pictures is presented on the response screen 850, theautomated hearing test verbally presents one of the words 856 to thepatient, preferably at a constant level. The level at which the word isverbally presented is chosen so that the patient is mostly like tocorrectly hear the word presented. Usually the same word from each set852 is verbally presented. It is possible for some sets 852 to haveoverlapping pictures, but the same exact set 852 of pictures should notbe repeated. The automated hearing test randomly chooses the sets 852 ofpictures from a large pool of such sets, then presents one word fromeach set at a constant level. The patient testing component 308thereafter waits for the patient to select the picture or word from theresponse screen 850 that matches the verbally presented word. Theautomated hearing test continues this procedure until either asufficient percentage of correct responses has been received (e.g., 85percent), or a large enough sample has been obtained to give an accurateassessment.

In some embodiments, the patient management component 310 includes acongratulatory screen 860 that is used to notify the patient andcongratulate him for successfully completing the hearing related tests.In some cases, the congratulatory screen 860 may also be accompanied bya verbal congratulatory message informing the patient that he hascompleted the tests and, if appropriate, the patient will now be giveninstructions for a survey.

An example of a survey instructions screen is shown at 870. The purposeof the survey instructions screen 870 is to instruct the patientregarding how to take the survey. Thus, the survey instruction screen870 may include a set of instructions 872 that tell the patient, forexample, that he should read the questions and then select the bestanswer. An example of the survey is given at 874. In some embodiments, averbal message may also be presented that explains the survey in moredetail. For example, the verbal message may explain that the purpose ofthe survey is to gather information about the patient to help thehearing health professional provide a diagnosis and recommend treatment,if necessary.

Once the instructions are completed, the patient is presented with asurvey screen 880. The survey screen includes a survey question 882followed by a set of answers 884. After the patient reads the question,he may then select the best answer from the set of answers 884. Thisprocess is continued until all the survey questions have been answered.

FIG. 9 illustrates an exemplary implementation of the patient managementcomponent 310. As mentioned above, the function of the patientmanagement component 310 is to notify the operator and/or patient of anyproblems or contingencies that may have arisen, and to generally helpthe patient stay on course through the testing. For example, if thepatient is not responding during a test, or is responding too quickly,the patient management component 310 may issue an on-screen warning tothe patient. The warning may include a short text message describing theproblem to the patient, and may include an on-screen acknowledgment suchas an “Okay” button or a “Continue” button. The patient must thenacknowledge the warning by pressing the acknowledgement button in orderto continue testing. A verbal warning may also accompany the on-screenwarning.

If the patient's responses indicate that there is an equipment problemor some other problem that requires the operator's attention, theautomated hearing test may alert the operator. Alerting the operator maybe accomplished by wireless paging or by any other suitable techniques(e.g., e-mail, console lights, buzzer, etc.). In the event that theoperator needs to be paged, the patient management component 310 mayinclude a paging screen 900 that can be used to inform the patient thatthe operator is being paged. For example, the paging screen 900 mayinclude a short text message saying that the operator is being paged andthat the patient should simply wait for the operator to come in.

FIGS. 10A-10F illustrate an exemplary implementation of the reportingcomponent 312 of the user interface 208. The reporting component 312allows the operator to view the results of the hearing test, and to savethem in various formats (e.g., xml, html, etc.). In some embodiments,the reporting component 312 includes a reporting screen 1000 from whichthe operator may select a number of options. For example, the operatormay press the redo some tests button 1002 to redo one or more hearingrelated tests. Selecting this button returns the operator to the newsession screen 400, but the patient's basic information is retained sothat one or more tests may be performed again without re-entering thebasic information. Pressing the new session button 1004 returns theoperator to the new session screen 400, but clears the basic informationfields so that new information may be entered.

Pressing the view reports button 1006 allows the operator to search andview the results of previous hearing tests saved on the system 100.Pressing the print billing button 1008 prints the billing informationassociated with the patient, including insurance codes for servicesrendered. Pressing the print report button 1010 prints a full reportthat contains all the relevant results of the patient's hearing testthat a physician usually would like to see.

An exemplary report that may be generated when the view report 1006button is pressed can be seen from the report screen 1020. The reportscreen 1020 may present the results of the hearing test in a two-panelformat, with the results of the right ear in one chart 1022, and theresults of the left ear in another chart 1024. Note that only a portionof the results can be seen here, and that the entire report may beviewed by scrolling down the screen as needed. The charts 1022 and 1024are computer-generated audiograms that reflect the patient's performancefor a particular test (e.g., the air and bone conduction test). Othercharts are available for other tests within a specific test session, aswell as charts from multiple test sessions for a particular patient. Therelevant data for each chart is also displayed (generally at 1026), aswell as some basic information (generally at 1028), including thepatient's name, date and time of the test, chart number, the physician,the tester, the clinic, and the elapsed time for the test.

A save report button 1030 allows the operator to save the results of thecurrent hearing test. Pressing this button brings up a save reportdialog box (not expressly shown) that allows the operator to specify aname for the report and to save the report under that name.

A change report style button 1032 allows the operator to change thestyle of the report from the two-panel format to, for example, aone-panel format 1040, where data for both ears are presented in onechart. As can be seen, the one-panel format 1040 includes a single chart1042 along with the data therefor (generally at 1044). Basic information1046 about the patient is also provided. Navigation buttons 1048 allowsthe operator to navigate around the report.

A view saved report button 1034 allows the operator to view reports thathave been previously saved. Note that this task can also be performed bypressing the view reports button 410 from the new sessions screen 400 inFIG. 4. Pressing either button brings up a search screen 1050, fromwhich the operator may search for previously saved reports to open andview. The search screen 1050 includes a plurality of search criteria1052 that the operator can use to find previously saved reports.Pressing the search button initiates the search. Pressing the displayall button 1054 displays all of the previously saved reports.

The reporting component 312 also includes a search result screen 1060that presents the results of the search. This screen lists all theavailable reports 1062 that match the one or more search parameters fromthe report search dialog box 1050. The reports are listed in thisexample according to the date they were taken, but they may certainly belisted in some other order if desired. In addition to the dateinformation, other information about the reports may also be shown, suchas the patient name, the chart number, the test time, the clinic, thephysician overseeing the test, and the operator administering the test.In some embodiments, each patient's name and chart number is a hyperlink1064 that takes the operator to the report associated with thatpatient's name or chart number. As mentioned previously, in someembodiments, each report can be viewed as a web page using any suitableweb browser.

The result screen also includes a log hyperlink 1066 that allows theoperator to view a log for any report. The log includes a listing ofevery action taken by the patient and/or operator (e.g., picked thewrong picture for a word) during the test as well as every action takenby the automated hearing test (e.g., increased intensity at 5 kHz by oneincrement). A data hyperlink 1068 to the data allows the operator toview the raw data for any test session. A tympanogram hyperlink 1070allows the operator to view the tympanogram, acoustic reflex, andotoacoustic reflex results. And an audiogram hyperlink 1072 to theaudiogram allows the operator to view the audiogram (e.g., chart 1022)by itself without the rest of the report.

Other aspects of the search result screen 1060 may include a pluralityof checkboxes (shown generally at 1074), each checkbox corresponding toone of the reports listed, that allows the operator to select severalreports. A compare button 1076 allows the operator to view a comparisonof the reports that have been selected. Pressing this button brings up acompare screen 1080 that includes a comparison of the data charts fromthe selected reports, shown at 1082 and 1084, for the right and leftears of the patient. The charts 1082 and 1084 are computer-generatedcharts that show a comparison of the patient's performance for aparticular test (e.g., the air and bone conduction test). Similarcomparisons may also be performed for other hearing related tests aswell. In some embodiments, for the reports being compared, the olderresults will be displayed less prominently, and the newer results willbe displayed more prominently. A comparison of the relevant data for thecharts is also displayed (generally at 1086 and 1088), as well as somebasic information (generally at 1090), including the patient's name,dates and times of the test, chart numbers, the physician, the tester,the clinic, and the elapsed time for the more recent test. A navigationbutton 1096 allows the operator to return to the previous screen.

As mentioned above, pressing the print report button 1010 prints a fullreport that contains all the relevant results of the patient's hearingtest. FIGS. 11A-11C illustrate an exemplary hearing test report 1100according to embodiments of the invention. As can be seen in FIG. 11A,the report 1100 may have several sections, including a test resultssection 1102, a test summary section 1104, a medical recommendationssection 1106, a patient history section 1108, and possibly one or moreother sections 1110 (e.g., medical release, billing, etc.). Thesevarious sections 1102-1110 together provide a single report that isconcise, convenient, and thorough. Note that some of these sections, forexample, the test results section 1102, were discussed briefly abovewith respect to the reporting component 312.

In accordance with embodiments of the invention, one or more of thesections 1102-1110 may include interpretive comments regarding theresults of the hearing related tests in the report 1100. Theinterpretive comments are generated by the interpretive commentscomponent 314 (FIG. 3) of the user interface 208. As alluded to above,the interpretive comments component 314 may be a modular, stand-alonecomponent that is capable of accepting data from and passing data toother functional components. The interpretive comments component 314generates the interpretive comments based on the same data received bythe results reporting component 312. This modularized approach allowsthe interpretive comments component 314 to function independently ofother functional components such that it may be removed from the userinterface 208 and/or inserted into another user interface (not expresslyshown) with little or no modification. The interpretive comments providea sort of guide through the test results for the audiologist or otherhearing health professional, noting potential inconsistencies,asymmetries, and areas of concern in the test results and, whereappropriate, may recommend certain types of medical treatment in someinstances. In no instances, however, are the interpretive commentsintended to replace the judgment or medical evaluation of theaudiologist or hearing health professional.

For the pure tone frequency threshold tests, the interpretive commentsprovide information about the degree and the type of hearing loss. Thedegree of hearing loss refers to the severity of the loss and may becharacterized as “normal,” “mild,” “moderate,” “severe,” or “profound.”These characterizations are based on accepted audiology standards andare dictated by the range where the patient's results fall, but it isalso possible to customize the characterizations if desired. The typesof hearing loss may range from “normal,” “mixed,” and “unspecified” toother types of hearing loss. An exemplary list of hearing loss types isprovided below in Table 1 along with a brief description of each. InTable 1, the term “SNHL” refers to sensorineural hearing loss. TABLE 1Type Description Normal No hearing loss detected. Essentially normal Allvalues except one fall within the normal range or all pure tones arewithin normal limits with a mild air-bone gap noted. SNHL Hearing lossdetected with no air-bone gaps greater than 10 dB noted. PredominatelySNHL Hearing loss detected with minimal air-bone gaps and normaltympanogram (if data available). Conductive Hearing loss detected withsignificant air-bone gaps noted and bone thresholds less than 25 dB.Mixed Hearing loss detected with air-bone gaps noted and at least onebone threshold greater than 20 dB. Unspecified Hearing loss cannot beclassified because bone conduction scores do not clearly define the typeof hearing loss (e.g., SNHL, conductive, mixed, etc.).Inconsistent/Incomplete data Test results do not fall within softwareguidelines and are unable to be interpreted.

To arrive at the appropriate type of hearing loss for the pure tonefrequency threshold test, the interpretive comments component appliesthe test results to a set of rules that are based on the gap between theair conduction threshold and the bone conduction threshold. Table 2below provides an exemplary list of the air-bone gap rules that may beused to derive the type of hearing loss for the pure tone frequencytest. These rules are intended to be examples only and a different setof rules may certainly be used depending on the particular application.In Table 2, the term “limit” refers to the audiology equipment limit(i.e., the audiology equipment has reached its maximum capability) andthe tympanometry type refers to industry accepted tympanometryclassifications. TABLE 2 Rule Condition 1 All gaps are less than orequal to 10 dB AND the number of gaps that are less than −10 dB is lessthan two AND all other gaps are −10 dB. 2 The gap at 500 Hz is less than10 dB AND the gaps at 1 KHz, 2 KHz, and 4 KHz are less than or equal to10 dB AND the number of gaps less than −10 dB is less than two AND allother gaps are greater than −10 dB. 2.1 The gap at 500 Hz is equal to 15dB AND the gaps at 1 KHz, 2 KHz, and 4 KHz are less than or equal to 10dB and the tympanometry is Type A and the number of gaps less than −10dB is less than two AND all other gaps are greater than −10 dB. 3 Thegaps at 500 Hz and 1 KHz are greater than 10 dB AND are not at the limitAND the number of gaps greater than −10 dB is greater than two AND allother gaps are less than −10 dB; OR the gaps at 1 KHz and 2 KHz are lessthan 10 dB AND are not at the limit AND the number of gaps greater than−10 dB is greater than two AND all other gaps are less than −10 dB; ORthe gaps at 2 KHz and 4 KHz are less than 10 dB AND are not at the limitAND the number of gaps greater than −10 dB is greater than two AND allother gaps are less than −10 dB. 3.1 The gaps at 2 KHz and 4 KHz aregreater than 10 dB AND are both at the limit AND the tympanometry isType A (if no tympanometry data is available, then the gap at 500 Hz and1 KHz must be less than 15 dB); OR the gap at 4 KHz is greater than 10dB AND at the limit AND the tympanometry is Type A (if no tympanometrydata is available, then the gaps at 500 Hz and 1 KHz must be less than15 dB). 4 The gap at 1 KHz is greater than 10 dB AND the number of gapsless than −10 dB is less than two AND all other gaps are greater than−10 dB; OR the gap at 2 KHz is greater than 10 dB AND the number of gapsless than −10 dB is less than two AND all other gaps are greater than−10 dB; OR the gap at 4 KHz is greater than 10 dB AND the number of gapsless than −10 dB is less than two AND all other gaps are greater than−10 dB AND the gap at 500 Hz is less than 15 dB. 5 The gaps at 500 Hz, 1KHz, 2 KHz, 4 KHz are greater than 10 dB AND are not at the limit ANDthe number of gaps less than −10 dB is less than two AND all other gapsare greater than −10 dB; OR the gaps at 500 Hz, 1 KHz, 2 KHz are greaterthan 10 dB AND are not at the limit AND the number of gaps less than −10dB is less than two AND all other gaps are greater than −10 dB; OR thegaps at 1 KHz, 2 KHz, and 4 KHz are greater than 10 dB AND are not atthe limit AND the number of gaps less than −10 dB is less than two ANDall other gaps are greater than −10 dB. 6 All bone scores are at thelimit and the tympanometry is Type A.

Using the above set of air-bone gap rules, the interpretive commentscomponent is able to determine the hearing loss type for the pure tonefrequency threshold test. The interpretive comments component candetermine the hearing loss type if certain air-bone gap rules are truealong with certain conditions. An exemplary combination of rules andconditions required for each hearing loss type is shown in Table 3. InTable 3, references to “Rule” refer to the rules listed in Table 2 aboveand “#1,” “#2,” and “#3” indicate different circumstances under whichthe hearing loss type may occur. TABLE 3 Type Condition Normal All airthresholds less are than or equal to 20 dB; AND All bone thresholds areless than or equal to 20 dB; AND Rule #1 is true. Essentially normal #1No air thresholds are greater than 30 dB; AND One air threshold isgreater than 20 dB; AND Rule #1 is true or Rule #4 is true. Essentiallynormal #2 All bone thresholds are less than 25 dB; AND Rule #2.1 is trueor Rule #4 is true; AND All air thresholds are less than 25 dB.Essentially normal #3 Air threshold for 8 KHz is greater than 20 dB; ANDAll other air thresholds are less than 25 dB; AND Rule #1 is true.Predominately SNHL Two or more thresholds are greater than 20 dB; ANDRule #4 or Rule #3.1 is true. Predominately SNHL All air scores aregreater than bone scores; (“severe” to “profound” AND Rule #6 is true.degrees of hearing loss) SNHL Two or more thresholds greater than 20 dB;Rule #1 is true. Conductive All bone thresholds less than or equal to 20dB; AND Rule #2 or Rule #3 or Rule #5 is true. Conductive All bonethreshold less than or equal to 20 dB; (Predominately SNHL) AND Rule#2.1 is true; AND Two or more air thresholds greater than 20 dB. MixedTwo air thresholds greater than 20 dB; AND One or more bone thresholdgreater than 20 dB; AND Rule #2 or Rule #3 or Rule #5 is true. Mixed Twoair thresholds greater than 20 dB; AND (Predominately SNHL) One or morebone threshold greater than 20 dB; AND Rule #2.1 is true. Unclassified#1 Two or more air thresholds greater than 20 dB; AND No bone conductionscores. (Label as “predominately SNHL as indicated by air conduction andthe tympanometry/acoustic reflex results” if the tympanometry is Type Aand one or more ipsi reflexes are present. Unclassified #2 Two or moreair thresholds greater than 20 dB; AND All gap rules are false. (Labelas “predominately SNHL as indicated by air conduction and thetympanometry/acoustic reflex results” if the tympanometry is Type A andone or more ipsi reflexes are present. All other circumstances Label as“insufficient/inconsistent data.”

Interpretive comments may also be generated for the speech receptionthreshold (SRT) test. For this test, the interpretive comments note thecorrelation of the SRT and predicted SRT for each ear to alert theaudiologist or other hearing health professional to any potentially poorquality tests. Thus, possible interpretive comments for the SRT testinclude: “consistent” if the SRT scores are within 10 dB of each other;“marginally consistent” if the SRT scores are within 20 dB of eachother, and “inconsistent” if the SRT scores have a greater than 20 dBdifference. A comment of “marginally consistent” or “inconsistent” onthe SRT score means that the audiologist or hearing health professionalshould reconsider the validity of the test results. This may occur if apatient is malingering or is unable to provide reliable responses forthe SRT and/or the pure tone test.

For the Distortion Product-Otoacoustic Emissions (DP-OAE) test, theinterpretive comments indicate whether the individual scores pass orfail and whether the overall results pass or fail for each ear.

Interpretive comments are also available for the speech discriminationtest. The speech discrimination test score is calculated by subtractingthe actual speech discrimination score from the predicted speechdiscrimination score. Based on these speech discrimination loss score,the interpretive comments may include, for example, “Normal” if thediscrimination loss is between 0-19% and “Unexpected Loss” if thediscrimination loss is 20% or greater. A loss of 20% or higher isconsidered to be a pathological indication.

In some embodiments, interpretive comments may also indicateasymmetries. Comments denoting asymmetries are presented, for example,if a significant difference is found for the pure tone threshold test.Since this test compares the right and left ear pure tone air conductionscores at each frequency, it is susceptible to asymmetrical results.Thus, if there is more than a 15 dB difference between the two ears at agiven frequency, an asymmetrical comment is noted and the frequencylisted accordingly. An asymmetrical comment may also be noted toindicate that the SRT scores show a difference of 20 dB or more betweenthe two ears. Finally, an asymmetrical comment may be noted to indicatethat the speech discrimination scores show a greater than 20% differencebetween the two ears.

As mentioned above, in some embodiments, the report 1100 may alsosuggest medical recommendations based on the test results. The medicalrecommendations are generated by the interpretive comments component andmay include several types of recommendations: medicalreferral/treatment, amplification, hearing conservation, re-testing, andthe like. These recommendations are typically accompanied by acomprehensive case history and medical examination in order to determinethe most appropriate next steps. Of course, fewer or additional types ofrecommendations may also be presented depending on the applicationwithout departing from the scope of the invention.

Exemplary recommendations for medical referral/treatment include, forexample, “Likely” and “Unlikely.” “Likely” is used if the results showmixed or conductive hearing loss. The “Likely” recommendation may alsobe triggered by asymmetrical pure tones thresholds for two or morefrequencies, discrimination loss of 20% or more in either ear, orconductive or mixed hearing loss with significant air-bone gaps ineither ear that are corroborated by tympanometry results (if data isavailable). Since all of these results are suggestive of other medicalproblems that may require medical treatment or evaluation, theinterpretive comments recommend that the patient is referred fortreatment. “Unlikely” is used if no asymmetries, significant air-bonegaps or speech discrimination loss is reported. A recommendation of“Possible-unspecified loss, retest/referral may be needed” is presentedif the hearing loss type is determined to be “unspecified” (which may bedue to the absence of bone conduction results).

Amplification recommendations are based on the average of the two worstpure tone frequencies from 500 Hz to 4 KHz. Examples of recommendationsfor amplification include: “None” if the average is less than 35 dB;“Recommended” if the average is 35 dB or greater, the hearing loss issensorineural, and the medical referral/treatment recommendation is“Unlikely”; “Reassess after medical referral/treatment” if the averageof the two worst pure tone thresholds between 500 Hz and 4 KHz is 35 dBor greater and the medical referral/treatment recommendation is“Likely.” The “Reassess after medical referral/treatment” commentindicates that one of the following was reported on the results:conductive or mixed hearing loss, speech discrimination loss, orsignificant asymmetry for the pure tone thresholds.

Exemplary recommendations for conservation/hearing protection typicallyinclude “recommended” in order to urge the patient to always beprotective of his hearing. Exemplary recommendations for retesttypically include “1 year” or “as needed” in order to encourage thepatient to obtain regular follow-ups.

The foregoing interpretive comments may be displayed on the report 1100in one or more of the sections 1102-1110, as will now be described withrespect to FIGS. 11B and 11C. Turning first to FIG. 11B, the resultssection 1102 may have several subsections, with the number ofsubsections depending on the number of hearing tests conducted on thepatient. In the example shown here, the results section 1102 has foursubsections. The subsections include an air and bone conductionsubsection 1112, a speech intelligibility subsection 1114, and atympanogram/DP-OAE subsection 11 16.

The first subsection, namely, the air and bone conduction subsection1112, is similar to the one discussed previously with respect to thereport screen 1020 (FIG. 10B). For example, information about thepatient, generally indicated at 1120, is provided at the top of page.The results of the air and bone conduction test for the patient's rightear and left here are then provided via charts in a two-panel format.(It is also possible, of course, to report the results of the air andbone conduction test in a one-panel format with the data for both earsplotted in the same chart.) The right ear results are shown in the rightchart 1122 and the left ear results are shown in the left chart 1124.The charts 1122 and 1124 are computer-generated audiograms that reflectthe patient's performance for the air and bone conduction tests. Theplacement of the right chart 1122 on the left side and the left chart1124 on the right side allows the audiologist or other hearing healthprofessional to line up the charts with the patient's ears when facingthe patient.

On the charts 1122 and 1124, the horizontal axis represents thefrequency and the vertical axis represents the thresholds. In accordancewith embodiments of the invention, the vertical axis is partitioned intofive regions, including “normal,” “mild,” “moderate,” “severe,” and“profound.” Each region indicates a distinct degree of hearing loss.Although five regions are shown here, it is possible to have fewer ormore than five regions of hearing loss without departing from the scopeof the invention. In some embodiments, each region of hearing loss maybe shown in a different color, shading, or pattern in order to help theaudiologist or other hearing health professional more clearlydistinguish between the different regions. In some embodiments, the boneconduction data points may be surrounded by shading or otherwisehighlighted to indicate a masking dilemma. A masking dilemma occurs whenthe minimum masking level required at the non-test ear also masks thetest ear due to crossover, causing the thresholds in the test ear to beshifted.

The numerical data for each chart 1122 and 1124 is reported in tableform at 1126 and 1128. Each row of the tables 1126 and 1128 displays ahearing threshold while each column represents a certain frequency. Inthe exemplary implementation shown here, there are five rows, includinga row for the air conduction threshold, the bone conduction threshold,the air-bone gap, the air conduction threshold with masking, and thebone conduction threshold with masking. For each cell in the tables 1126and 1128, the data may be displayed with certain indicators to indicatethe quality and/or reliability level of the test results. For example, asuperscripted “F” indicates that the patient's false response ratio,which is the number of false responses over the total number ofresponses, has exceeded a certain predefined limit (e.g., 40%). By wayof background, a false response refers to a response that is receivedoutside a predefined response window (i.e., the patient responded eithertoo early or too late and is therefore considered to be guessing). Asuperscripted “T” indicates that the number of presentations required toobtain a threshold for the patient at a given frequency has exceeded apredefined limit (e.g., 18) considered to be a cutoff for good quality.A subscripted “NR” indicates that for some presentations, no responsewas received. And similarly to the charts 1122 and 1124, some boneconduction test results may be highlighted to indicate that the boneconduction loss prevented masking from being effectively presented.Another subscripted indicator, “U,” indicates that masking wasinsufficient during the presentation. Blank cells indicate no data.

In some embodiments, a legend 1130 may also be present to explain themeaning of the various symbols and markers displayed in the air and boneconduction subsection 1112. The symbols are standard symbols used bymost audiologist and hearing health professionals, but may certainly bemodified as needed for a particular application.

The speech intelligibility subsection 1114 displays, again in tableform, the results of the speech related hearing tests, including thespeech reception threshold test and the speech discrimination test. Forthe speech reception threshold test, the speech intelligibilitysubsection 1114 displays the results of the average best pure-tonehearing within a speech range, the predicted SRT, and the lowestintensity level at which speech can still be understood by the patient.For the speech discrimination test, the speech intelligibilitysubsection 1114 displays the speech discrimination presentation level,the speech discrimination test score that is predicted by audibilityfactors alone, and the actual speech discrimination test score. (Theaudibility factors are based on the results of the patient's pure tonefrequency thresholds.) In some embodiments, the speech intelligibilitysubsection 1114 also displays any speech discrimination loss that is notexplained by the pure tone loss. This unexplained loss may be derived bysubtracting the predicted speech discrimination test score and theactual speech discrimination test score.

In the exemplary implementation shown here, the speech intelligibilitysubsection 1114 includes a column for the description 1132 of eachspeech related test result described in the previous paragraph, a columnfor the measure 1134 used with each test (e.g., pure tone air conduction(PTA), SRT, etc.) along with a column for the units therefor, and acolumn for the results for the right ear 1136 and the left ear 1138. Insome embodiments, the numbers in columns 1136 and 1138 may be shown withmasking indicators, for example, a subscripted “msk” to indicate maskingwas presented and a superscripted number (e.g., “5”) to indicate theintensity level of the masking. In some embodiments, the actual speechdiscrimination test score may be accompanied by the possible range ofthe testing error, as well understood by those having ordinary skill inthe art.

The tympanogram/DP-OAE subsection 1116 presents the results of anacoustic admittance test (in the form of a tympanogram) and the DP-OAEtest. In the exemplary implementation shown here, the tympanogram/DP-OAEsubsection 1116 includes a tympanogram 1140 for the patient's right andleft ears, reflecting the results of the acoustic admittance test. Thenumerical data for each ear is also reported in table form at 1142 and1144 for the right and left ears, respectively, with the left column ineach table listing the test type and the right column indicating theresults. Another table displays the DP-OAE results at 1146 and 1148 forthe right and left ears, respectively. As discussed above, theinterpretive comments for the DP-OAE results are intended to indicatepass or fail for the individual scores as well as the overall results.In the example shown here, “OK” indicates a passing score and “X”indicates a failing score.

A comments subsection 1150 may also be present in some embodiments forproviding interpretive comments about the tympanogram, for example,whether the tympanometry for each ear is “normal” or otherwise. Thecomments subsection 1150 may also provide an AMA (American MedicalAssociation) hearing score in some embodiments that indicates thepercentage of a disability that is caused by the patient's hearing loss.The AMA hearing score requires a pure tone threshold at 3 KHz in orderto be able to calculate the score. If a threshold is not available at 3KHz, then the automated hearing test uses data from available thresholdsto extrapolate the 3 KHz threshold. The extrapolated threshold is thenused to calculate an Estimated Person Impairment score that is similar,to and may be used in lieu of, the AMA hearing score. Where available,the comments subsection 1150 may also provide information regardingwhether the patient has passed Stenger screening (e.g., “Stenger at 500Hz is Negative,” etc.). For information regarding Stenger screening inan automated hearing test, the reader is referred to U.S.Non-provisional Application entitled “Stenger Screening in AutomatedDiagnostic Hearing Test,” filed concurrently herewith, and incorporatedherein by reference.

FIG. 11C shows an exemplary implementation of the test summary section1104 for providing interpretive comments regarding various hearingrelated tests according to embodiments of the invention. As can be seen,the test summary section 1104 may include a table showing a descriptionof the various tests at 1152 and the interpretive comments therefor forthe right ear and the left ear, respectively, at 1154 and 1156. The testtypes may include, for example, the pure tone threshold test, SRT,speech discrimination test, tympanogram, DP-OAE. The interpretivecomments for these tests may be the same as the ones discussedpreviously, or they may include other test types and interpretivecomments as needed. The summary section 1104 may also note anyasymmetries in the pure tone threshold test, SRT, and speechdiscrimination test, along with the interpretive comments therefor. Insome embodiments, the results of the acoustic reflex test and thepatient survey (e.g., the HHIE survey) may also be presented in thissection. A synopsis of the various results and interpretive commentstherefor may be provided with the summary table at 1158 in someembodiments.

In addition to the summary section 1104, FIG. 11C also shows anexemplary implementation of the medical recommendations section 1106.Again, the information is provided in the form of a table, with thetypes of recommendations listed in one column at 1160 and therecommendations themselves listed in another column at 1162. The varioustypes of recommendations and the recommendations themselves may be thesame as the ones discussed previously, or they may be a modifiedversion, depending on the particular application.

As for the patient history section 1108, in some embodiments, thepatient history section 1108 provides a list of possible symptoms thatthe patient may have experienced, indicated at 1164. The symptoms aretypical symptoms, known to those of ordinary skill in the art, that apatient with hearing related problems may experience. An audiologist orother hearing health professional may then manually mark (e.g., “Yes” or“No”) whether the patient has the symptoms for the right and left ears,as applicable, at 1166 and 1168, respectively. Comments may also beentered for each symptom at 1170 as needed.

Finally, the report 1100 may include one ore more other sections 1110,such as a medical release section. The medical release section allowsthe audiologist or other hearing health professional to either refer thepatient to a specialist for further treatment or to release the patient,for example, as having no contraindications that would affect fittingfor a hearing aid. An example of a medical release is illustrated at1110 in FIG. 11C. In some embodiments, billing information may also bepresented in the report 1100, including information relating to thecharges for the various hearing tests and other billing relatedinformation.

While the invention has been described with respect to a number ofspecific embodiments, those skilled in the art will recognize that theinnovative concepts described herein can be modified and varied over awide range of applications. Accordingly, the scope of the inventionshould not be limited to any of the specific exemplary teachingsdiscussed, but is instead defined by the following claims.

1. A method of presenting a patient's hearing test results in anautomated diagnostic hearing test, comprising: presenting the patient'shearing test results from the automated diagnostic hearing test on areport; presenting one or more interpretive comments on the report basedon the patient's hearing test results, the one or more interpretivecomments pointing out possible inconsistencies, asymmetries, or areas ofconcern in the test results; and presenting one or more medicalrecommendations on the report based on the patient's hearing testresults and the one or more interpretive comments.
 2. The methodaccording to claim 1, wherein one or more of the patient's hearing testresults are presented in graphical form.
 3. The method according toclaim 1, further comprising presenting one or more quality and/orreliability indicators with the patient's hearing test results.
 4. Themethod according to claim 1, further comprising presenting one or moremasking indicators with the patient's hearing test results.
 5. Themethod according to claim 1, wherein the patient's hearing test resultsinclude results from at least one of the following tests: pure tonethreshold, speech reception, speech discrimination, tympanogram,distortion product-otoacoustic emissions.
 6. The method according toclaim 1, wherein the interpretive comments include at least a degree ofhearing loss and a type of hearing loss.
 7. The method according toclaim 6, wherein the type of hearing loss is derived based on aplurality of air-bone gap rules.
 8. The method according to claim 1,wherein the one or more medical recommendations include at least one ofthe following types of medical recommendations: medicalreferral/treatment, amplification, hearing conservation, and re-testing.9. A system for reporting a patient's hearing test results in anautomated diagnostic hearing test, comprising: transducers, including anair conduction transducer and a bone conduction transducer; a hearingtest device connected to the transducers; a computer connected to thehearing test device and storing a user interface for an automatedhearing test thereon, the user interface configured to cause thecomputer to: present the patient's hearing test results from theautomated diagnostic hearing test on the report; present one or moreinterpretive comments on the report based on the patient's hearing testresults, the one or more interpretive comments pointing out possibleinconsistencies, asymmetries, or areas of concern in the test results;and present one or more medical recommendations on the report based onthe patient's hearing test results and the one or more interpretivecomments.
 10. The system according to claim 9, wherein the userinterface is further configured to cause the computer to present one ormore of the patient's hearing test in graphical form.
 11. The systemaccording to claim 9, wherein the user interface is further configuredto cause the computer to present one or more quality and/or reliabilityindicators with the patient's hearing test results.
 12. The systemaccording to claim 9, wherein the user interface is further configuredto cause the computer to present one or more masking indicators with thepatient's hearing test results.
 13. The system according to claim 9,wherein the patient's hearing test results include results from at leastone of the following tests: pure tone threshold, speech reception,speech discrimination, tympanogram, distortion product-otoacousticemissions.
 14. The system according to claim 9, wherein the interpretivecomments include at least a degree of hearing loss and a type of hearingloss.
 15. The system according to claim 14, wherein the type of hearingloss is derived based on a plurality of air-bone gap rules.
 16. Thesystem according to claim 9, wherein the one or more medicalrecommendations include at least one of the following types of medicalrecommendations: medical referral/treatment, amplification, hearingconservation, and re-testing.
 17. A computer-readable medium comprisingcomputer-readable instructions for generating interpretive comments inan automated diagnostic hearing test, the computer-readable instructionscomprising instructions for: receiving a patient's hearing test resultsfrom the automated diagnostic hearing test; generating one or moreinterpretive comments based on the patient's hearing test results, theone or more interpretive comments including at least a degree of hearingloss and a type of hearing; and generating one or more medicalrecommendations based on the patient's hearing test results and the oneor more interpretive comments.
 18. The computer-readable mediumaccording to claim 17, wherein the computer-readable instructionsfurther comprise instructions for generating one or more quality and/orreliability indicators for the patient's hearing test results.
 19. Thecomputer-readable medium according to claim 17, wherein the type ofhearing loss is derived based on a plurality of air-bone gap rules. 20.The computer-readable medium according to claim 17, wherein the one ormore medical recommendations include at least one of the following typesof medical recommendations: medical referral/treatment, amplification,hearing conservation, and re-testing.